Physician Compare National (NPI:1447424403)

HEALTHCARE PROVIDER: DAN BANNISTER LICSW

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1447424403
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2466686837
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200302001650
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BANNISTER
	Individual professional last name
Provider First Name	DAN
	Individual professional first name
Provider Middle Name	W
	Individual professional middle name
Provider Name Suffix Text	III
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF IOWA, RJ & L CARVER COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1987
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	CEDAR RAPIDS KEYS TO LIVING
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	0042559312
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	4
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1642 42ND ST NE
	Group Practice or individual's line 1 address
City	CEDAR RAPIDS
	Group Practice or individual's city
State	IA
	Group Practice or individual's state
Zip Code	524023076
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3193772161
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y